| NPI | 1902344278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: DC NP1043124) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1043124) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R224563) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2025-08-29 |